Jacqueline D Wallace, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1016638 Issued in MA

Practice address

447 West St
Suite #3
Amherst, MA 01002-2933

Phone

(413) 253-2893

Fax

(413) 253-2893

NPI assigned

Oct 12, 2005

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374537600000",
    "number": "1497743504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 JENKS ST",
            "city": "AMHERST",
            "state": "MA",
            "postal_code": "010021640",
            "telephone_number": "413-253-5457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "447 WEST ST",
            "address_2": "SUITE #3",
            "city": "AMHERST",
            "state": "MA",
            "postal_code": "010022933",
            "telephone_number": "413-253-2893",
            "fax_number": "413-253-2893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JACQUELINE",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "MSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-10-12",
        "last_updated": "2013-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "1016638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Marie Vona, MSN, RN
• Taylor Wadsworth
• Julia Esther Wald, LICSW
• Martin Walder, D.C.
• William Waldsmith
• Jody Lynn Wallace, LICSW
• Walsh Resolutions, LLC
• Paul J Walting, MD
• Susan S. Wang, M.D.
• Cicely Wannamaker, LCSW

• Clinical Social Worker in Amherst, MA
• Providers in Amherst, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.